Effect of Radial-to-Femoral Access Crossover on Adverse Outcomes in Primary Percutaneous Coronary Intervention Lorenzo Azzalini, MD, MSc, Razi Khan, MD, Malek Al-Hawwas, MD, Raja Hatem, MD, Annik Fortier, BSc, Philippe L. L’Allier, MD, and Hung Q. Ly, MD, MSc* We aimed to describe the impact of the vascular access used when patients are treated with primary percutaneous coronary intervention (PPCI) and to assess whether this translates into differences in angiographic outcomes. Patients with ST-elevation myocardial infarction who underwent PPCI were divided into 3 groups: successful radial access (RA), successful femoral access (FA), and Crossover (failed RA with need for bailout FA) groups. Vascular accesserelated time (VART) was defined as the delay in PPCI that can be attributed to vascular accesserelated issues. Study end point was the final corrected Thrombolysis In Myocardial Infarction frame count. Multivariable analysis was used to identify predictors of RA failure (RAF: FA D Crossover). We included 241 patients (RA, n [ 172; FA, n [ 49; Crossover, n [ 20). Mean VART was longer in Crossover (10.3 [8.8 to 12.4] minutes), relative to RA (4.1 [3.2 to 5.5] minutes) and FA (4.6 [3.4 to 8.4] minutes, p